Ryan, Kline, And Upton Unveil More Specifics About Obamacare Supreme Court Contingency Plans
Yesterday, three key Republican senators on health care issues published an op-ed in which they outlined the broad principles of how they would address potential outcomes in the big Obamacare Supreme Court case, King v. Burwell. Today, three House Republican leaders—Paul Ryan (Wisc.), John Kline (Minn.), and Fred Upton (Mich.)—unveiled their own plan, with important new details. It's a significant step forward.
The new op-ed, published in the Wall Street Journal, outlines an “off-ramp from Obamacare” which would transition enrollees in interested states into a better system. The three congressmen chair three House committees with major impact on health care policy: Ways and Means (Ryan), Energy and Commerce (Upton), and Education and the Workforce (Kline). All three were involved in the working group organized by Sen. John Barrasso (Wyo.) and the Republican Policy Committee.
Liberalizing insurance markets
Under the Ryan-Kline-Upton plan, states could opt out of Obamacare's blizzard of insurance mandates and regulations. Instead, residents of those states could use Obamacare's tax credits to buy a broad range of insurance plans, like the ones that were available before the new health law.
The plan wouldn't eliminate all federal regulations, however. Ryan et al. would “prohibit insurers from imposing lifetime limits on benefits” and “protect people with existing conditions.”
Tax credits to purchase health insurance
The plan would deploy advanceable and refundable tax credits, as Obamacare does, to help the uninsured purchase health insurance. The credit would be larger for older people, since their health costs are higher, relative to younger people.
Importantly, the plan is silent on the question of whether or not the tax credits would be means-tested or uniform. In other words: would people with six-figure salaries get the same subsidy as those nearing the poverty line? The Obamacare replacement plan proposed by Upton and two senators employs means-tested subsidies, in which lower-income individuals would get more help. Paul Ryan, in the past, has favored programs with uniform tax credits.
This difference may seem too wonky, but it has a meaningful impact on the number of people with health insurance. An earlier version of the Upton plan—the Coburn-Burr-Hatch plan—has been estimated to cover 3 million more people than Obamacare in 2020; the version revised by Upton covers 3 million fewer than the ACA. But a plan with uniform tax credits scored by the same group—the Center for Health and Economy—would cover 6 million fewer people than the ACA. The two chairmen appear to have set aside that debate for now, but Democrats will be sure to criticize any plan that covers fewer people, whatever its merits otherwise.
Other traditional GOP reforms
The Ryan-Kline-Upton plan would also embrace the traditional suite of incremental Republican reforms, such as medical-liability reform, buying insurance across state lines, and association health plans, in which small businesses collaborate to create larger insurance pools and lower costs.
The Ryan plan is a significant step forward
What's significant about the Ryan-Kline-Upton plan is that it firmly takes the side of using advanceable, refundable tax credits to help the uninsured buy health insurance. My sources on the Hill tell me that Rep. Ryan and his colleagues have been investing an enormous amount of time meeting with other House members to help walk them through the plan.
With Sen. Tom Coburn (Okla.) retired, Paul Ryan is the undisputed leader of entitlement reformers in Congress. By lending his considerable prestige and credibility to the Supreme Court contingency plan, Republicans may indeed have a fighting chance of putting something real on the table.
This piece originally appeared in Forbes
This piece originally appeared in Forbes